Understanding Perinatal Intrusive Thinking
During pregnancy and the first year of a baby’s life (the perinatal period), we expect new parent’s thoughts and daydreams to be filled with excitement and joy, including thoughts about the future and anticipation about what is to come- the first moment you meet your baby; watching your baby adoringly as they fall sleep; showing them the world and watching them grow and learn. So it can come as a huge and nasty shock for most people (approximately 90%) when their brain starts throwing them unwanted and distressing thoughts and/or images of harm coming toward their baby.
Intrusive thoughts are thoughts (and/or images) that are unwanted, occur suddenly “out of the blue”, or sometimes in response to the environment (e.g. walking stairs with baby), and most importantly are not in your control. For many, these thoughts can cause significant distress. The most common intrusive thoughts that occur in the perinatal period are thoughts of accidental or intentional harm towards your baby. You may even find yourself changing your behaviours in response to these thoughts. For example, asking your partner to hold the baby when walking stairs “just in case”. In some severe cases, these thoughts can feel so scary and overpowering that the parent may start to completely avoid touching or interacting with their baby out of fear of causing them harm.
For many people, these thoughts fly in and out of their mind without much consideration. However, some may find themselves interpreting these thoughts as significantly meaningful, and begin to fear that the thoughts may actually be an indication that this harm will occur or that they may act on the thoughts (e.g. harm baby).
Obsessive Compulsive Disorder (OCD) occurs when a person experiences intrusive thoughts, and then feel compelled to respond with behaviours and/or thoughts (e.g. mental acts) in order to reduce the distress caused by the intrusive thought. These behaviours and/or thoughts (e.g. counting, replacing images with other images) can become ritualistic or repetitive in nature (i.e. compulsions). For example, experiencing an intrusive thought that baby is going to stop breathing when they are sleeping in the cot, and reducing your distress by repeatedly checking the baby monitor or even going into the room to touch baby and make sure they are breathing. Reading that last part you may be thinking, oh my gosh I do that all the time! Well, a lot of parents have done this- but the difference is whether these thoughts and behaviours cause you significant distress and/or interfere with your daily functioning (e.g. not just checking once or twice, but experiencing repeated significant distress and going back to check over 20 times during the course of baby’s nap, etc.)
Common intrusive thoughts of accidental harm:
During pregnancy:
Baby dying in utero: I have ingested something that will harm baby; what if I get sick and baby dies;
Postpartum:
Baby has stopped breathing (often when they are sleeping) or suffocated (e.g. wrapped in blankets)
Dropping baby when holding them
Accidentally poisoning baby (e.g. overdosing pain relief; food preparation)
Intrusive thinking can also include that of intentionally harming your baby, and occurs for around 50% of new parents. These thoughts are understandably highly distressing, deeply confusing (as you actually do not want any harm to come to baby) and unfortunately can be easily misunderstood by those around as being a sign of high risk toward the child or even psychosis- causing increased anxiety and distress for the person experiencing the thoughts. Due to this misunderstanding, women (or men- yes dads can also experience these thoughts) are often left silent to deal with the thoughts alone out of fear that they may lose their baby or others may treat them as dangerous toward their baby.
Common unwanted intrusive thoughts related to intentional harm toward baby include;
Violent harm: Stabbing, cutting, throwing, suffocating, drowning, poisoning
Sexual abuse— this type of intrusive thinking can be significantly distressing and is often paired with high levels of avoidance behaviours that can cause serious interference in a persons life - e.g. avoid changing baby nappy’s, avoid bathing or being alone with baby
It is important to know that intrusive thinking in the perinatal period is distinctly different to postpartum psychosis- a rare but very serious condition that requires immediate intervention and which can render infants at risk if left untreated.
Common symptoms and signs of postpartum psychosis that differ from intrusive thinking:
Intense and rapid mood swings (can present as a significant change of personality, or can present as emotionally distant or cold)
Loss of reality including disorientation and confusion
Irrational, false beliefs (e.g. delusions, for example believing others can hear their thoughts; believing that the baby is possessed)
Hallucinations (e.g. experiencing sensations that are not actually present)
Paranoia or suspicion of others
Insomnia
If you are seriously concerned about yourself or someone else experiencing postpartum psychosis you can contact the Mental Health Line on 1800 011 511 or present to your nearest emergency department.
So why do intrusive thoughts happen? Why would the brain do this to us!
Well, the brain goes through a lot of change during pregnancy and into the postpartum period becoming a parent. A pretty significant goal for the brain is to increase our fear and threat response in preparation for caring for a highly vulnerable and dependant infant. This means that where the brain wouldn’t see risk before, suddenly it is ringing alarm bells all the time- sending us information to be aware of in order to successfully protect baby! Again, for many these thoughts will feel like a random and weird blip in the brain and won’t be considered as meaningful. However, if it does feel meaningful and we respond to the thoughts with avoidance or panic, then our brain takes that information and decides “oh wait so you are concerned about that thing- okay then I will just keep sending you more red flags whenever I think the risky situation is back”. So the thoughts get louder, you notice them more, you assign more importance to the thoughts because they keep happening, then the brain sends you more- and around and around we go!
So what can we do to manage these thoughts?
Firstly we need to understand that these thoughts- despite how horrible they may be- are not the enemy. They are our brains way of trying to help keep us and our baby safe. This can mean a little bit of unlearning if you have come to fear these thoughts or tried to suppress them. If you are experiencing OCD, and engaging in behavioural or mental responses to reduce the distress of the intrusive thinking, then the first line of evidence-based treatment is Exposure and Response Prevention (ERP)- this essentially involves exposing you to the distressing intrusive thoughts (e.g. often through a trigger) and building skills in order to prevent engaging in the response that you feel compelled to do. Over time and with practice not responding to the thought with a compulsion, the brain can learn that the thought itself is safe, which can reduce the distress overall- or at the very least you learn that you can cope with the distress as it will pass, and that you don’t need to be ruled by your thoughts! That way you can get back to the important things like making memories with bub.
If you think you may be experiencing perinatal intrusive thinking or OCD, feel free to contact us here and find out more about how we can help.
If you would like to read more about Perinatal OCD, check out International OCD Foundation or PANDA for more information.
Written by Sophie Lynn-Evans